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Prevalence and factors associated with health insurance coverage in urban sub-Saharan Africa: Multilevel analyses of demographic and health survey data

Author

Listed:
  • Hubert Amu
  • Kwamena Sekyi Dickson
  • Kenneth Setorwu Adde
  • Kwaku Kissah-Korsah
  • Eugene Kofuor Maafo Darteh
  • Akwasi Kumi-Kyereme

Abstract

Introduction: With the vision of achieving Universal Health Coverage (UHC) by the year 2030, many sub-Saharan African (SSA) countries have implemented health insurance schemes that seek to improve access to healthcare for their populace. In this study, we examined the prevalence and factors associated with health insurance coverage in urban sub-Saharan Africa (SSA). Materials and methods: We used the most recent Demographic and Health Survey (DHS) data from 23 countries in SSA. We included 120,037 women and 54,254 men residing in urban centres in our analyses which were carried out using both bivariable and multivariable analyses. Results: We found that the overall prevalence of health insurance coverage was 10.6% among females and 14% among males. The probability of being covered by health insurance increased by level of education. Men and women with higher education, for instance, had 7.61 times (95%CI = 6.50–8.90) and 7.44 times (95%CI = 6.77–8.17) higher odds of being covered by health insurance than those with no formal education. Males and females who read newspaper or magazine (Males: AOR = 1.47, 95%CI = 1.37–1.57; Females: AOR = 2.19, 95%CI = 1.31–3.66) listened to radio (Males: AOR = 1.29, 95%CI = 1.18–1.41; Females: AOR = 1.42, 95%CI = 1.35–1.51), and who watched television (Males: AOR = 1.80, 95%CI = 1.64–1.97; Females: AOR = 1.86, 95%CI = 1.75–1.99) at least once a week had higher odds of being covered by health insurance. Conclusion: The coverage of health insurance in SSA is generally low among urban dwellers. This has negative implications for the achievement of universal health coverage by the year 2030. We recommend increased public education on the benefits of being covered by health insurance using the mass media which we found to be an important factor associated with health insurance coverage. The focus of such mass media education could target the less educated urban dwellers, males in the lowest wealth quintile, and young adults (15–29 years).

Suggested Citation

  • Hubert Amu & Kwamena Sekyi Dickson & Kenneth Setorwu Adde & Kwaku Kissah-Korsah & Eugene Kofuor Maafo Darteh & Akwasi Kumi-Kyereme, 2022. "Prevalence and factors associated with health insurance coverage in urban sub-Saharan Africa: Multilevel analyses of demographic and health survey data," PLOS ONE, Public Library of Science, vol. 17(3), pages 1-14, March.
    • Handle: RePEc:plo:pone00:0264162
    DOI: 10.1371/journal.pone.0264162
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    References listed on IDEAS

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    1. Hubert Amu & Kwamena Sekyi Dickson, 2016. "Health insurance subscription among women in reproductive age in Ghana: do socio-demographics matter?," Health Economics Review, Springer, vol. 6(1), pages 1-8, December.
    2. Chemouni, Benjamin, 2018. "The political path to universal health coverage: Power, ideas and community-based health insurance in Rwanda," World Development, Elsevier, vol. 106(C), pages 87-98.
    3. Elisabeth Paul & N’koué Emmanuel Sambiéni & Jean-Pierre Wangbe & Fabienne Fecher & Marc Bourgeois, 2020. "Budgeting challenges on the path towards universal health coverage: the case of Benin," Health Economics Review, Springer, vol. 10(1), pages 1-8, December.
    4. Elisabeth Paul & N'koué Emmanuel Sambiéni & Jean-Pierre Wangbe & Fabienne Fecher & Marc Bourgeois, 2020. "Budgeting challenges on the path towards universal health coverage: the case of Benin," ULB Institutional Repository 2013/312499, ULB -- Universite Libre de Bruxelles.
    5. Juan Merlo & Philippe Wagner & Nermin Ghith & George Leckie, 2016. "An Original Stepwise Multilevel Logistic Regression Analysis of Discriminatory Accuracy: The Case of Neighbourhoods and Health," PLOS ONE, Public Library of Science, vol. 11(4), pages 1-31, April.
    6. Obinna Onwujekwe & Kara Hanson & Benjamin Uzochukwu, 2012. "Examining Inequities in Incidence of Catastrophic Health Expenditures on Different Healthcare Services and Health Facilities in Nigeria," PLOS ONE, Public Library of Science, vol. 7(7), pages 1-6, July.
    7. Hubert Amu & Kwamena Sekyi Dickson & Akwasi Kumi-Kyereme & Eugene Kofuor Maafo Darteh, 2018. "Understanding variations in health insurance coverage in Ghana, Kenya, Nigeria, and Tanzania: Evidence from demographic and health surveys," PLOS ONE, Public Library of Science, vol. 13(8), pages 1-14, August.
    8. Hayley Pierce & Ashley Larsen Gibby & Renata Forste, 2016. "Caregiver Decision-Making: Household Response to Child Illness in Sub-Saharan Africa," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 35(5), pages 581-597, October.
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